Free AMERICAN PAIN by John Temple Page A

underutilized even in their pill-swamped communities. The doctor who co-chaired the foundation said the Purdue grant had no effect on the foundation’s work. Years later, he lost his medical license after airport officials found oxyco-done and hydrocodone bottles with other people’s names on them among his luggage. A subsequent investigation revealed that a number of his patients had died of overdoses.

    Purdue targeted the doctors who controlled the prescription pads. Most physicians had received maybe an hour or two of pain management training way back in med school. They needed a re-education in painkillers, and Purdue supplied it with the largest narcotics marketing campaign ever. Between 1996 and 2002, Purdue funded more than twenty thousand pain-related educational programs, almost ten a day, seven days a week. During the same years, Purdue conducted more than forty national pain management training conferences at resorts in Boca Raton and Scottsdale, paying the travel costs for more than five thousand physicians who attended. More than twenty-five hundred physicians were on Purdue’s speaker bureau list. They went home with plush toys, fishing hats, CDs, and pens, all branded with the OxyContin logo. A favorite freebie was the heat-sensitive Oxy-Contin mug that bore the words: “The one to start with . . . .” When filled with hot coffee, the rest of the slogan materialized: “The one to stay with.”
    The educational seminars made the most of the unfounded statistic that “fewer than one percent” of patients would develop addictions. One continuing medical education program sponsored by Purdue promoted opioid therapy as the only solution for chronic conditions such as back pain. The program contained a role-playing exercise in which a patient admits he is taking twice as many pills as he’s supposed to. An authoritative narrator cautions the doctor not to jump to the conclusion that the patient is addicted, even if he seems desperate. The role play ends with the doctor prescribing a high-dose opioid.
    Purdue doubled its sales force during those years, from 318 to 767 pharmaceutical reps. In the trade, the reps are called detailers, and they’re typically good-looking, gregarious, and well-dressed. They remember the names of the clinic receptionists and secretaries and nurses. Purdue expected each drug rep to develop a list of 105 to 140 physicians within a specific sales region and call each one every three or four weeks. And they didn’t target only oncologists and pain management specialists. They went after family doctors and general practitioners, a broader and less painkiller-savvy prescriber. Purdue paid its reps better than most drug-makers paid theirs—by 2001, an average salary of $55,000 and an average bonus of $71,500. Purdue spent a half-billion dollars on the one-on-one sales strategy between 1996 and 2001.
    Purdue drug reps also had another tool: OxyContin coupons. Free samples were a common way to promote a new medication, but the DEA didn’t allow it with controlled substances like OxyContin. So in 1998 and 1999, Purdue bypassed this rule by giving each rep twenty-five coupons for a free thirty-day supply of the drug. In 2000 and 2001, as OxyContin’s reputation grew, the company cut the free trials to seven days. Reps gave the coupons to doctors, who passed them on to patients. The freebies cost Purdue $4 million a year, but in the narcotics business, it was a good long-term strategy.
    Purdue drilled its reps on two selling points. One, OxyContin was the first narcotic that wouldn’t hook patients. And two, fewer than 1 percent of pain-management patients get addicted anyway.
    Purdue’s army of drug reps reminded Golbom of the salesmen a century earlier who peddled patent medicines like Hamlin’s Wizard Oil or Hostetter’s Celebrated Stomach Bitters, men who assured their customers that a bottle of snake oil would cure everything from arthritis to kidney disease.

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